Abstract
In children with deep carious lesions, the tooth’s pulp can become inflamed. If this lesion is not treated properly, the caries can approximate the pulp resulting in pain and infection. The treatment of these pulp conditions often results in extraction or root canal therapy. Vital pulp therapy procedures can treat the decay approximating the pulp to avoid the pulp becoming infected or being treated with pulpotomy. An alternative to pulpotomy, extraction, or pulpectomy for deep carious lesions where the pulp is vital is indirect pulp treatment (IPT). IPT has been shown to be successful using stepwise caries excavation in two appointments or using partial caries excavation as a one-appointment procedure. These procedures are indicated for primary, immature permanent, and mature permanent teeth in children and adolescents. Direct pulp capping in primary teeth due to a carious exposure is not indicated but is used in permanent teeth. This chapter will review the literature and systematic reviews on these treatments, show their advantages and disadvantages, and offer conclusions as to the treatment of choice.
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References
AAPD Reference Manual. Guideline on pulp therapy for primary and immature permanent teeth. 2014–2015;36:242–50.
Coll JA, Campbell A, Chalmers NI. Effects of glass ionomer temporary restorations on pulpal diagnosis and treatment outcomes in primary molars. Pediatr Dent. 2013;35:416–21.
Bergenholtz G, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Petersson A, Portenier I, Sandberg H, Tranæus S, Mejare I. Treatment of pulps in teeth affected by deep caries – a systematic review of the literature. Singapore Dent J. 2013;34(1):1–12.
Smith AJ, Cassidy N, Perry H, Begue-Kirn C, Ruch JV, Lesot H. Reactionary dentinogenesis. Int J Dev Biol. 1995;39:273–80.
Marshall GW, et al. The dentin substrate: structure and properties related to bonding. J Dent. 1997;25:441–58.
Fusayama T. Two layers of carious dentin: diagnosis and treatment. Oper Dent. 1979;4:63–70.
Bjorndal L. Dentin and pulp reactions to caries and operative treatment: biological variables affecting treatment outcome. Endod Top. 2002;2:10–23.
Johnson W, Taylor BR, Berman DS. The response of deciduous dentine to caries studied by correlated light and electron microscopy. Caries Res. 1969;3:348–68.
Mjör IA. Dentin-predentin complex and its permeability. Pathology and treatment. Overview. J Dent Res. 1985;64(spec issue):621–7.
Edwardsson S. Bacteriology of dentin caries. In: Thylstrup A, Leach SA, Qvist V, editors. Dentine and dentine reactions in the oral cavity. Oxford: IRL Press; 1987. p. 95–102.
Kidd EAM, Smith BGN, Pickard HM. Pickard’s manual of operative dentistry. 7th ed. Oxford: Oxford University Press; 1998.
Schwendicke F, Dörfer CE, Paris S. Incomplete caries removal: a systematic review and meta-analysis. J Dent Res. 2013;92:306–14.
Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database Syst Rev. 2013;(3):CD003808.
Elderton RJ. Clinical studies concerning re-restoration of teeth. Adv Dent Res. 1990;4:4–9.
Murray PE, Smith AJ, Windsor LJ, Mjör IA. Remaining dentine thickness and human pulp responses. Int Endod J. 2003;36:33–43.
Fuks AB. Pulp therapy for the primary dentition. In: Pinkham JR, Casamassimo PS, Fields Jr HW, McTigue DJ, Nowak A, editors. Pediatric dentistry: infancy through adolescence. 5th ed. St. Louis: Elsevier Saunders Co; 2013. p. 331–51.
Bjørndal L, Reit C, Bruun G, Markvart M, Kjældgaard M, Näsman P, et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci. 2010;118:290–7.
Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA. The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study. J Am Dent Assoc. 2006;137:1699–705.
Bogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: an observational study. J Am Dent Assoc. 2008;139:305–15.
Bjørndal L, Larsen T, Thylstrup A. A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res. 1997;31:411–7.
Wambier DS, dos Santos FA, Guedes-Pinto AC, Jaeger RG, Simionato MR. Ultrastructural and microbiological analysis of the dentin layers affected by caries lesions in primary molars treated by minimal intervention. Pediatr Dent. 2007;29:228–34.
Bjørndal L, Kidd E. The treatment of deep dentine caries lesions. Dent Update. 2005;32:402–4, 407–10, 413.
Maltz M, Moura MS, Jardim JJ, et al. Partial caries removal in deep lesions: 19–30 months follow-up study. Rev Fac Odontol Porto Alegre. 2010;51:20–3.
Maltz M, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM, Moura MS, et al. Randomized trial of partial vs. stepwise caries removal. J Dent Res. 2012;91:1026–31.
Innes NP, Evans DJ, Stirrups DR. The Hall technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral Health. 2007;7:18.
Innes NPT, Evans DJP, Stirrups DR. Sealing caries in primary molars; randomized control trial. 5-year results. J Dent Res. 2011;90:1405–10.
Ludwig KH, Fontana M, Vinson LA, Platt JA, Dean JA. The success of stainless steel crowns placed with the Hall technique: a retrospective study. J Am Dent Assoc. 2014;145(12):1248–53.
Santamaria RM, Innes NP, Machiulskiene V, Evans DJ, Splieth CH. Caries management strategies for primary molars: 1-yr randomized control trial results. J Dent Res. 2014;93:1062–9.
Mertz-Fairhurst EJ, Curtis JW, Ergle JW, Rueggeberg FA, Adair SM. Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc. 1998;129:55–66.
Holan G, Eidelman E, Fuks AB. Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatr Dent. 2005;27:129–36.
Hutcheson C, Seale NS, McWhorter A, Kerins C, Wright J. Multi-surface composite vs stainless steel crown restorations after mineral trioxide aggregate pulpotomy: a randomized controlled trial. Pediatr Dent. 2012;34(7):460–7.
Guelmann M, Bookmyer KL, Villalta P, GarcÃa-Godoy F. Microleakage of restorative techniques for pulpotomized primary molars. J Dent Child. 2004;71:209–11.
Seale NS, Coll JA. Vital pulp therapy for the primary dentition. Gen Dent. 2010;58(3):194–200.
Kuhn E, Chibinski AC, Reis A, Wambier DS. The role of glass ionomer cement on the remineralization of infected dentin: an in vivo study. Pediatr Dent. 2014;36(4):E118–24.
Corralo D, Maltz M. Clinical and ultrastructural effects of different liners/restorative materials on deep carious dentin: a randomized clinical trial. Caries Res. 2013;47:243–50.
Orhan AI, Oz FT, Orhan K. Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Pediatr Dent. 2010;32:347–55.
Casagrande L, Bento LW, Rerin SO, Lucas Ede R, Dalpian DM, de Araujo FB. In vivo outcomes of indirect pulp treatment using a self-etching primer versus calcium hydroxide over the demineralized dentin in primary molars. J Clin Pediatr Dent. 2008;33:131–5.
Trairatvorakul C, Sastararuji T. Indirect pulp treatment vs antibiotic sterilization of deep caries in mandibular primary molars. Int J Paediatr Dent. 2014;24:23–31.
Vij R, Coll JA, Shelton P, Farooq NS. Caries control and other variables associated with success of primary molar vital pulp therapy. Pediatr Dent. 2004;26:214–20.
Farooq NS, Coll JA, Kuwabara A, Shelton P. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent. 2000;22:278–86.
Al-Zayer MA, Straffon LH, Feigal RJ, Welch KB. Indirect pulp treatment of primary posterior teeth: a retrospective study. Pediatr Dent. 2003;25:29–36.
Roberts J. Indirect pulp treatment vs. Formocresol pulpotomy in human primary molars: a randomized controlled trial. A thesis. The Texas A&M University System Health Science Center. 2009. Accessed at http://pqdtopen.proquest.com on 8 Aug 2015.
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Coll, J.A. (2016). Indirect Pulp Treatment, Direct Pulp Capping, and Stepwise Caries Excavation. In: Fuks, A., Peretz, B. (eds) Pediatric Endodontics. Springer, Cham. https://doi.org/10.1007/978-3-319-27553-6_4
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DOI: https://doi.org/10.1007/978-3-319-27553-6_4
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